3 yr old girl “mentally ill”? and now dead

Paragraphs 32 & 33 read: “Greg, 45, and Angela, 30, were previously diagnosed with bipolar disorder. It is a manic-depressive illness affecting up to 3 percent of the population.”

“At Prairie View, Kliewer decided Destiny suffered the same ailment. She was put on Geodon and Seroquel. The dosage of Seroquel was ramped up to 600 milligrams per day by Kliewer.”

Paragraph 9 reads: “Angela said hospital physician Lora Siegle concluded the dosage of Seroquel authorized by Kliewer was inappropriately high for a 38-pound child. Siegle’s hospital notes say, ‘I will stop the medications.’ The doctor considered sending Destiny to Children’s Mercy Hospital in Kansas City, Mo., but decided to care for the girl herself.”

Child’s death a tragic destiny

SUBMITTED
Destiny Hager’s ashes will be buried Wednesday on what would have been her seventh birthday.

TIM CARPENTER/THE CAPITAL-JOURNAL
Greg and Angela Hager will bury their 3-year-old daughter, Destiny, this week, three years after she died. They blame medication and lax medical attention for the mentally ill child’s death.

By Tim Carpenter
Created June 6, 2009 at 10:37pm
Updated June 7, 2009 at 12:10am

COUNCIL GROVE ­ Destiny Hager could be delightfully charming and frightfully aggressive.

In her darkest moments, the 3-year-old smashed her head against walls, lashed out at family members and bit herself. She battled insomnia. Her mood swings were sharp. She tried to suffocate a dog.

Her condition demanded intervention. Counselors directed Destiny and her parents, Angela and Greg Hager, to Prairie View hospital in Newton. Vernon Kliewer, a child psychiatrist in whom the Hagers placed trust but now condemn, prescribed two powerful drugs to control Destiny.

The tiny girl with shoulder-length brown hair was tranquilized by the medical regimen. But the Hagers were uncomfortable with dosages obliterating Destiny’s personality. They scheduled a doctor’s visit to wean her from medication.

Destiny began complaining of a stomachache three days before the appointment. Her pain appeared to ease, but it later mushroomed. She was raced to a hospital. Her anguished cries echo in Angela’s memory.

“The sound of it stays with me every day,” she said. “If you can picture a wounded animal in a trap trying to free itself, that’s what she sounded like.”

Destiny died within hours.

After three years of searching, and with their daughter’s burial finally only days away, both parents have lingering questions about Destiny’s death. They don’t feel all physicians who treated Destiny have been forthcoming. And they haven’t placed her demise in context of a complex national debate about medicating children with mental illness.

Code blue

Destiny was carried through the doors of Morris County Hospital at 11:20 p.m. April 3, 2006. An X-ray revealed her colon was blocked ­ a known side effect of Seroquel and Geodon prescribed by Kliewer.

Angela said hospital physician Lora Siegle concluded the dosage of Seroquel authorized by Kliewer was inappropriately high for a 38-pound child. Siegle’s hospital notes say, “I will stop the medications.” The doctor considered sending Destiny to Children’s Mercy Hospital in Kansas City, Mo., but decided to care for the girl herself.

At 7:40 a.m., Destiny stopped breathing inside Room 11. A minister was called. Siegle managed to resuscitate Destiny. The girl was able to speak in a halting manner.

“I love you,” Destiny told her parents.

She required emergency surgery, but the modest hospital in this town of 2,300 wasn’t staffed for the procedure.

A medical helicopter was called to transport Destiny to Children’s Mercy. Her pulse faded twice more, but doctors brought her back both times. Before LifeFlight departed, Angela said, a member of the air ambulance crew hugged the Hagers and offered advice.

Destiny was pronounced dead at 10:34 a.m. on April 4 following a 45-minute flight.

The lives of Angela and Greg became a blur. Viewing their daughter’s lifeless body was crushing. An attempt to donate her organs failed. Later, strangers made them victims of malicious allegations. They also were beneficiaries of heartwarming empathy.

The Hagers hired the Wichita law firm of Hutton and Hutton to press a wrongful death lawsuit against Kliewer, Siegle and Morris County Hospital. Legal wrangling proceeded until December 2008 when Hutton and Hutton withdrew from all litigation involving Destiny. The law firm never fully explained to the Hagers’ satisfaction their reason for pulling out, the couple said.

The decision followed autopsy confirmation that Destiny died of fecal impaction and had “antipsychotic drugs present in concentrations considered therapeutic in adults.” The action came amid reports Geodon increased risk of potentially fatal heart-rhythm irregularities and people on Seroquel were more likely to suffer sudden cardiac death than patients taking older antipsychotics.

The Hagers’ attorneys walked away as state regulators completed a two-year investigation of Kliewer that found the doctor violated Kansas law while treating Destiny and five other children.

The Hagers say their own checkered past may have sabotaged this quest for justice and clarity.

About Destiny

Angela turned on the television in the family’s one-story house outside Council Grove. She launched a DVD prepared for Destiny’s memorial service. Greg couldn’t bear to again watch the slideshow chronicling the life of a child from June 10, 2002, to April 4, 2006.

Angela fought back tears, but narrated scenes set to music.

“That was the day we brought her home from the hospital,” she said. “That was her last Christmas ­ 2005. She loved to sing and dance and pose. She was such a ham.”

As the final picture faded, she ticked off Destiny’s favorite activities: swimming, riding a toy horse, picking flowers, curling up to watch a movie.

Angela recalled giving her daughter nicknames. There was Moses, because Destiny tried to walk on water at age 1. Another was Mouse. It reflected Destiny’s habit of moving soundlessly across a room.

Destiny was born in Nebraska City, Neb. She moved frequently. She lived at times with her parents, a grandmother and friends. The Hagers were in Falls City, Neb., before coming to Council Grove.

“We came down for a visit, stayed a while and fell in love with the area,” Angela said.

Escalation

Angela became desperate to find help for Destiny. The staff at an Emporia clinic recommended a five-day stay at Prairie View. Greg didn’t like the idea, but relented.

Greg, 45, and Angela, 30, were previously diagnosed with bipolar disorder. It is a manic-depressive illness affecting up to 3 percent of the population.

At Prairie View, Kliewer decided Destiny suffered the same ailment. She was put on Geodon and Seroquel. The dosage of Seroquel was ramped up to 600 milligrams per day by Kliewer.

“He said a lot of doctors and a lot of people are going to say this is a really high dose,” Greg said. “But he says, ‘I feel comfortable with it.’ Those were his exact words.”

Kirsten Evraire, a spokeswoman for Seroquel manufacturer AstraZeneca, said the company “does not recommend” Seroquel for patients under 18. The same is true of Pfizer’s Geodon.

However, physicians routinely exercise authority to prescribe medicines for “off-label” conditions beyond uses endorsed by the U.S. Food and Drug Administration.

Russell Scheffer, professor of psychiatry and behavioral sciences at The University of Kansas School of Medicine in Wichita, said he has given Seroquel to children. He said 600 milligrams a day is reasonable. The medicine, he said, is an effective therapy for bipolarism. “These are serious disorders,” he said.

State inquiry

Kliewer, who has practiced medicine for 50 years, fell under the microscope of the Kansas Board of Healing Arts.

Board attorneys filed a petition in 2007 outlining the agency’s investigation of Kliewer’s treatment of Destiny and five other children ranging in age from 2 to 5. The agency concluded Kliewer deviated from the standard of care, improperly prescribed medications and failed to properly document treatment.

In Destiny’s case, Kliewer “inappropriately prescribed Seroquel and Geodon” after failing to “adequately assess and evaluate” her condition. Kliewer ignored evidence of physical and sexual abuse among the other children.

“Clearly, it’s severe enough they’ve taken disciplinary action,” said Jack Confer, executive director of the Board of Healing Arts. “They thought it was a violation of state law.” Kliewer was unwilling to comment.

The doctor negotiated a settlement in February with the Board of Healing Arts that didn’t require him to admit wrongdoing. He voluntarily stopped treating patients under age 6.

The Board of Healing Arts placed his medical license on indefinite probation. He was ordered to pay $13,079 to cover the board’s investigation expenses. Kliewer must have another physician monitor his treatment of bipolar patients.

Backlash

In the aftermath of Destiny’s death, Angela and Greg were placed on trial by innuendo.

Before they returned to Council Grove from the hospital in Kansas City, law enforcement officers declared their apartment a crime scene. Someone told police Destiny may have been mistreated.

“We were cleared that evening,” Greg said. “Our daughter was well taken care of. That child was not abused.”

Weird rumors persisted. Parents with children crossed to the other side of streets rather than walk past Angela. In a grocery store, someone accused the Hagers of murder.

The lawsuit put a spotlight on Angela and Greg. Attorneys for the county hospital and two doctors mined the Hagers’ background. Angela provided more ammunition in a deposition given last year to attorneys fighting the lawsuit.

Siegle’s attorney, Lisa McPherson, of Wichita, said the doctor stands by her work.

Destiny’s ashes will be buried Wednesday on what would have been her seventh birthday. The plot, which was donated, is in Kelso Cemetery north of Council Grove. The burial has been delayed so long because the couple couldn’t afford it.

Standing amid a collection of family photographs in the living room, Greg said he could feel his daughter’s presence despite her absence. “Maybe there’s a rainbow at the end,” Angela said. “Even if all we did was bring awareness.”

This web site is neither for advertising nor dispensing of medical advice. Clients who consult with Dr. Weeks receive information in an educational context in an effort to learn about optimizing care with their local health care practitioners. Dr. Weeks formerly practiced on Whidbey Island off the coast of Washington.

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Paragraphs 32 & 33 read: “Greg, 45, and Angela, 30, were previously diagnosed with bipolar disorder. It is a manic-depressive illness affecting up to 3 percent of the population.” “At Prairie View, Kliewer decided Destiny suffered the same ailment. She was put on Geodon and Seroquel. The dosage of Seroquel was ramped up to 600…